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General NPI Number Information
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NPI Number | 1063849404
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Entity Type | Individual
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Provider Name | MARYDALE MORGAN WORBOYS LCMHC
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Gender | Female
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 1130 S CHURCH ST STE C
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City | ASHEBORO
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State | NC
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Zip | 27203-6745
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Country | US
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Telephone | 336-629-9589
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Fax |
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Provider Business Mailing Address
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Address Line | 614 MORGAN COUNTRY RD
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City | ASHEBORO
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State | NC
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Zip | 27203-8342
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Country | US
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Telephone | 336-629-9589
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10319
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License Number State | NC
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